The causes of menorrhagia can vary widely between women, but there are some common issues at the root of unusually heavy bleeding. These include fibroids, low progesterone relative to estrogen (both common in perimenopause), PCOS, or other hormonal imbalance.

Occasionally an intrauterine device (IUD) could cause excessive menstrual bleeding, but his is not the norm unless there is an infection. Other less common problems, but ones that certainly need to be considered, include a thickened build up of tissue also called a thickened endometrium, uterine hyperplasia, polyps, uterine or cervical cancer, ectopic pregnancy, cervical lesions, pelvic inflammatory disease (PID), hypothalamic dysfunction, hyperprolactinemia, parathyroidism or other thyroid problems, even premature ovarian failure (POF).

When doing an initial workup, some practitioners will test a woman for vitamin K deficiency (vitamin K is necessary for maintaining blood-clotting platelets). A woman with bleeding issues may also have a coagulation problem (coagulopathy), or other blood-related (hematologic) causes. For example, genetic variants such as Von Willebrand’s disease, factor VIII, or factor XI deficiency are relatively uncommon, autosomal traits that may be suspected in a woman who has had heavy periods since menarche (first menstrual bleeding); bruising issues; or prolonged bleeding after surgery, childbirth, or trauma. In fact it is the first thing I will do if someone comes to me with heavy bleeding, since it’s often overlooked and can contribute a great deal to a patient’s understanding of what is going on in her body. Heavy menses may be the only sign of this genetic condition. See your practitioner if you suspect you have a clotting disorder, as it can be detected with a simple blood test, but often goes undiagnosed.

The truth is that we see heavy bleeding frequently, but rare disorders are not usually the cause. Our first and major concern for women with menorrhagia is anemia. A (CBC), better known as a complete blood count, identifies whether you are indeed anemic and need to add an iron supplement and more hormonal support to your daily regimen. If hormone levels are imbalanced, especially in perimenopause, we may want to try a combination of nutritional intervention and endocrine support for you. And though it’s certainly not my first choice, in severe cases where we need to control the bleeding, I will prescribe a synthetic form of progesterone like Aygestin or Provera. It does work extremely well and has its place when necessary.

I’m happy to say, though, that most cases of heavy periods can be brought under good control with diet and exercise modifications, along with a medical-grade nutritional supplement and progesterone support. It’s interesting to note that the time we see the most problems with heavy bleeding (outside the usual pattern for our patients) is around the holidays, when stress levels are often over the top for women.

Gentle phytonutrient support and the use of a pharmaceutical grade multivitamin (Click here to learn about our specially formulated one that offers) can also help keep your estrogen-to-progesterone levels on a much more even keel. But we always place equal weight on addressing the impact your emotions and stress have on your hormonal symphony. Once your body gets the support it needs, it usually resumes its normal menstrual cycles—without having to resort to surgery. We see this on a daily basis in the clinic and online. And if you don’t have to worry about how often you can make it to a restroom, you’re free once again to get out there and enjoy your life!

For more information, read our informative article, “Menorrhagia and Hypermenorrhagia.”